For some fifteen years already, the control of public managers over insurance physicians has been a political issue in the Netherlands. More control should lead to, among other things, a more limited system and an efficient bureaucracy. In this organisational ethnography it becomes clear that the public managers count themselves out, both literally and figuratively, with respect to these physicians. A paradox of transparency is that, in daily practice, the political call for making the medical insurance work transparent through figures mostly leads to a virtual reality that obscures the view of the concrete actions of (staff) insurance physicians. Moreover, in a power vacuum the district managers figuratively count themselves out. They try to avoid the insurance physicians. A paradox of this avoidance is that the physical absence of (staff) insurance physicians in the social interactions of the district managers actually has as a consequence that they are omnipresent, because they regularly are part of the underlying problems in the investigated social interactions, in particular in the cooperation problems.